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Estrup S, Barot E, Mortensen CB, Anthon CT, Crescioli E, Kjaer MBN, Vesterlund GK, Bruun CRL, Collet MO, Rasmussen BS, Sivapalan P, Poulsen LM, Møller MH, Perner A, Granholm A. Patient and public involvement in contemporary large intensive care trials: A meta-epidemiological study. Acta Anaesthesiol Scand 2023; 67:256-263. [PMID: 36537664 DOI: 10.1111/aas.14183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patient and public involvement in randomised clinical trials has received increased focus, including in intensive care trials, but the frequency, method and extent is unknown. This meta-epidemiological study investigated patient and public involvement in contemporary, large ICU trials. METHODS We systematically searched PubMed for large (≥225 randomised patients), contemporary trials (published between 1 January 2019 and 31 January 2022) assessing interventions in adult patients in ICU settings. Abstracts and full-text articles were assessed independently and in duplicate. Data were extracted using a pre-defined, pilot-tested data extraction form with details on trials, patient and public involvement including categories and numbers of individuals involved, methods of involvement, and trial stage(s) with involvement. Trials authors were contacted as necessary. RESULTS We included 100 trials, with 18 using patient and public involvement; these were larger and conducted in more centres than trials without patient and public involvement. Among trials with patient and public involvement, patients (in 14/18 trials), clinicians (13 trials), and family members (12 trials) were primarily involved, mainly in the development of research design (15 trials) and development of research focus (13 trials) stages and mostly by discussion (12 trials) and solo interviews (10 trials). A median of 65 individuals (range 1-6894) were involved. CONCLUSIONS We found patient and public involvement in a fifth of large, contemporary ICU trials. Primarily patients, families, and clinicians were included, particularly in the trial planning stages and mostly through interviews and discussions. Increased patient and public involvement in ICU trials is warranted.
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Affiliation(s)
- Stine Estrup
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Emily Barot
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Carl Thomas Anthon
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Elena Crescioli
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Gitte Kingo Vesterlund
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Bodil Steen Rasmussen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Praleene Sivapalan
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lone Musaeus Poulsen
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Kjær MN, Granholm A, Vesterlund GK, Estrup S, Sivapalan P, Bruun CRL, Mortensen CB, Poulsen LM, Møller MH, Christensen S, Strøm T, Laerkner E, Brøchner AC, Rasmussen BS, Vestergaard SR, Barot E, Madsen MB, Egerod I, Perner A, Collet MO. Development of a core outcome set for general intensive care unit patients-A protocol. Acta Anaesthesiol Scand 2022; 66:415-424. [PMID: 34961916 DOI: 10.1111/aas.14024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Different outcomes are reported in randomised clinical trials (RCTs) in intensive care unit (ICU) patients, and no core outcome set (COS) is available for ICU patients in general. Accordingly, we aim to develop a COS for ICU patients in general. METHODS The COS will be developed in accordance with the Core Outcome Measures in Effectiveness Trials (COMET) Handbook, using a modified Delphi consensus process and semi-structured interviews involving adults who have survived acute admission to an ICU, family members, clinicians, researchers and other stakeholders. The modified Delphi process will include two steps. Step 1: conduction of a modified Delphi survey, developed and informed by combining the outputs of a literature search of outcomes in previous COSs and semi-structured interviews with key stakeholders. We plan at least two survey rounds to obtain consensus and refine the COS. Step 2: a consensus process regarding instruments or definitions to be recommended for the measurements of the outcomes selected in Step 1. A 'patient and public involvement panel' consisting of a smaller group of patients, family members, clinicians and researchers will be included in the development, analysis and interpretation of the COS. DISCUSSION The outlined multiple method studies will establish a COS for ICU patients in general, which may be used to increase the standardisation and comparability of results of RCTs conducted in patients in the ICU setting.
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Affiliation(s)
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
| | - Gitte Kingo Vesterlund
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
| | - Stine Estrup
- Department of Anaesthesiology Zealand University Hospital Køge Denmark
| | - Praleene Sivapalan
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
| | | | | | | | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
| | | | - Thomas Strøm
- Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark
- Department of Anaesthesia and Critical Care Medicine Hospital Sønderjylland University Hospital of Southern Denmark Kolding Denmark
| | - Eva Laerkner
- Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | | | - Bodil Steen Rasmussen
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
| | - Stine Rom Vestergaard
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
| | - Emily Barot
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
| | - Martin Bruun Madsen
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
| | - Ingrid Egerod
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
| | - Marie Oxenbøll Collet
- Department of Intensive Care Copenhagen University Hospital—Rigshospitalet Copenhagen Denmark
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3
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Barot E, Kjær MN, Collet M, Crescioli E, Rasmussen BS, Estrup S, Mortensen CB, Vesterlund GK, Sivapalan P, Anthon CT, Bruun CRL, Poulsen LM, Møller MH, Perner A, Granholm A. Patient and public involvement in contemporary large intensive care trials: Protocol for a meta-epidemiological study. Acta Anaesthesiol Scand 2021; 65:1351-1354. [PMID: 34273181 DOI: 10.1111/aas.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient and public involvement (PPI) in randomized clinical trials (RCTs) has increased in recent years but remains the exception rather than the rule. We aim to assess the frequency and extent of PPI in large, contemporary RCTs conducted in an intensive care setting. METHODS AND DESIGN We will conduct a meta-epidemiological study of RCTs conducted in intensive care settings published since 2019 and assess their use of PPI. We will extract trial characteristics and verify the use of PPI with trial authors unless specifically stated in the published paper. The primary outcome will be the proportion of trials that use PPI. Secondary outcomes will explore which groups are consulted, at which stage of the trial process this occurs, and by what means these opinions are collected and implemented. DISCUSSION This meta-epidemiological study will provide an important insight into the use of PPI in large, contemporary intensive care trials. We wish to reveal ways in which patient involvement could be incorporated more broadly and purposefully here and help to empower clinicians, researchers and patients to collaborate further on future research processes and goals.
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Affiliation(s)
- Emily Barot
- Department of Intensive Care Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | | | - Marie Collet
- Department of Intensive Care Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Elena Crescioli
- Department of Anaesthesiology and Intensive Care Aalborg University Hospital Aalborg Denmark
| | - Bodil Steen Rasmussen
- Department of Anaesthesiology and Intensive Care Aalborg University Hospital Aalborg Denmark
| | - Stine Estrup
- Department of Anaesthesiology and Intensive Care Zealand University Hospital Køge Denmark
| | | | - Gitte Kingo Vesterlund
- Department of Intensive Care Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Praleene Sivapalan
- Department of Intensive Care Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Carl Thomas Anthon
- Department of Intensive Care Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | | | - Lone Musaeus Poulsen
- Department of Anaesthesiology and Intensive Care Zealand University Hospital Køge Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
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Juul S, Nielsen EE, Feinberg J, Siddiqui F, Jørgensen CK, Barot E, Holgersson J, Nielsen N, Bentzer P, Veroniki AA, Thabane L, Bu F, Klingenberg S, Gluud C, Jakobsen JC. Interventions for treatment of COVID-19: Second edition of a living systematic review with meta-analyses and trial sequential analyses (The LIVING Project). PLoS One 2021; 16:e0248132. [PMID: 33705495 PMCID: PMC7954033 DOI: 10.1371/journal.pone.0248132] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 is a rapidly spreading disease that has caused extensive burden to individuals, families, countries, and the world. Effective treatments of COVID-19 are urgently needed. This is the second edition of a living systematic review of randomized clinical trials assessing the effects of all treatment interventions for participants in all age groups with COVID-19. METHODS AND FINDINGS We planned to conduct aggregate data meta-analyses, trial sequential analyses, network meta-analysis, and individual patient data meta-analyses. Our systematic review was based on PRISMA and Cochrane guidelines, and our eight-step procedure for better validation of clinical significance of meta-analysis results. We performed both fixed-effect and random-effects meta-analyses. Primary outcomes were all-cause mortality and serious adverse events. Secondary outcomes were admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and non-serious adverse events. According to the number of outcome comparisons, we adjusted our threshold for significance to p = 0.033. We used GRADE to assess the certainty of evidence. We searched relevant databases and websites for published and unpublished trials until November 2, 2020. Two reviewers independently extracted data and assessed trial methodology. We included 82 randomized clinical trials enrolling a total of 40,249 participants. 81 out of 82 trials were at overall high risk of bias. Meta-analyses showed no evidence of a difference between corticosteroids versus control on all-cause mortality (risk ratio [RR] 0.89; 95% confidence interval [CI] 0.79 to 1.00; p = 0.05; I2 = 23.1%; eight trials; very low certainty), on serious adverse events (RR 0.89; 95% CI 0.80 to 0.99; p = 0.04; I2 = 39.1%; eight trials; very low certainty), and on mechanical ventilation (RR 0.86; 95% CI 0.55 to 1.33; p = 0.49; I2 = 55.3%; two trials; very low certainty). The fixed-effect meta-analyses showed indications of beneficial effects. Trial sequential analyses showed that the required information size for all three analyses was not reached. Meta-analysis (RR 0.93; 95% CI 0.82 to 1.07; p = 0.31; I2 = 0%; four trials; moderate certainty) and trial sequential analysis (boundary for futility crossed) showed that we could reject that remdesivir versus control reduced the risk of death by 20%. Meta-analysis (RR 0.82; 95% CI 0.68 to 1.00; p = 0.05; I2 = 38.9%; four trials; very low certainty) and trial sequential analysis (required information size not reached) showed no evidence of difference between remdesivir versus control on serious adverse events. Fixed-effect meta-analysis showed indications of a beneficial effect of remdesivir on serious adverse events. Meta-analysis (RR 0.40; 95% CI 0.19 to 0.87; p = 0.02; I2 = 0%; two trials; very low certainty) showed evidence of a beneficial effect of intravenous immunoglobulin versus control on all-cause mortality, but trial sequential analysis (required information size not reached) showed that the result was severely underpowered to confirm or reject realistic intervention effects. Meta-analysis (RR 0.63; 95% CI 0.35 to 1.14; p = 0.12; I2 = 77.4%; five trials; very low certainty) and trial sequential analysis (required information size not reached) showed no evidence of a difference between tocilizumab versus control on serious adverse events. Fixed-effect meta-analysis showed indications of a beneficial effect of tocilizumab on serious adverse events. Meta-analysis (RR 0.70; 95% CI 0.51 to 0.96; p = 0.02; I2 = 0%; three trials; very low certainty) showed evidence of a beneficial effect of tocilizumab versus control on mechanical ventilation, but trial sequential analysis (required information size not reached) showed that the result was severely underpowered to confirm of reject realistic intervention effects. Meta-analysis (RR 0.32; 95% CI 0.15 to 0.69; p < 0.00; I2 = 0%; two trials; very low certainty) showed evidence of a beneficial effect of bromhexine versus standard care on non-serious adverse events, but trial sequential analysis (required information size not reached) showed that the result was severely underpowered to confirm or reject realistic intervention effects. Meta-analyses and trial sequential analyses (boundary for futility crossed) showed that we could reject that hydroxychloroquine versus control reduced the risk of death and serious adverse events by 20%. Meta-analyses and trial sequential analyses (boundary for futility crossed) showed that we could reject that lopinavir-ritonavir versus control reduced the risk of death, serious adverse events, and mechanical ventilation by 20%. All remaining outcome comparisons showed that we did not have enough information to confirm or reject realistic intervention effects. Nine single trials showed statistically significant results on our outcomes, but were underpowered to confirm or reject realistic intervention effects. Due to lack of data, it was not relevant to perform network meta-analysis or possible to perform individual patient data meta-analyses. CONCLUSIONS No evidence-based treatment for COVID-19 currently exists. Very low certainty evidence indicates that corticosteroids might reduce the risk of death, serious adverse events, and mechanical ventilation; that remdesivir might reduce the risk of serious adverse events; that intravenous immunoglobin might reduce the risk of death and serious adverse events; that tocilizumab might reduce the risk of serious adverse events and mechanical ventilation; and that bromhexine might reduce the risk of non-serious adverse events. More trials with low risks of bias and random errors are urgently needed. This review will continuously inform best practice in treatment and clinical research of COVID-19. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178787.
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Affiliation(s)
- Sophie Juul
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
| | - Emil Eik Nielsen
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
- Department of Internal Medicine–Cardiology Section, Holbæk Hospital,
Holbæk, Denmark
| | - Joshua Feinberg
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
| | - Faiza Siddiqui
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
| | - Caroline Kamp Jørgensen
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
| | - Emily Barot
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
| | - Johan Holgersson
- Department of Clinical Sciences Lund, Anesthesia & Intensive Care,
Helsingborg Hospital, Lund University, Lund, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anesthesia & Intensive Care,
Helsingborg Hospital, Lund University, Lund, Sweden
| | - Peter Bentzer
- Department of Clinical Sciences Lund, Anesthesia & Intensive Care,
Helsingborg Hospital, Lund University, Lund, Sweden
| | - Areti Angeliki Veroniki
- Department of Primary Education, School of Education, University of
Ioannina, Ioannina, Greece
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St.
Michael’s Hospital, Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, ON, Canada
| | - Fanlong Bu
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese
Medicine, Beijing, China
| | - Sarah Klingenberg
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
| | - Christian Gluud
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit–Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense,
Denmark
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5
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Juul S, Nielsen EE, Feinberg J, Siddiqui F, Jørgensen CK, Barot E, Nielsen N, Bentzer P, Veroniki AA, Thabane L, Bu F, Klingenberg S, Gluud C, Jakobsen JC. Interventions for treatment of COVID-19: A living systematic review with meta-analyses and trial sequential analyses (The LIVING Project). PLoS Med 2020; 17:e1003293. [PMID: 32941437 PMCID: PMC7498193 DOI: 10.1371/journal.pmed.1003293] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a rapidly spreading disease that has caused extensive burden to individuals, families, countries, and the world. Effective treatments of COVID-19 are urgently needed. METHODS AND FINDINGS This is the first edition of a living systematic review of randomized clinical trials comparing the effects of all treatment interventions for participants in all age groups with COVID-19. We planned to conduct aggregate data meta-analyses, trial sequential analyses, network meta-analysis, and individual patient data meta-analyses. Our systematic review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Cochrane guidelines, and our 8-step procedure for better validation of clinical significance of meta-analysis results. We performed both fixed-effect and random-effects meta-analyses. Primary outcomes were all-cause mortality and serious adverse events. Secondary outcomes were admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and nonserious adverse events. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. We searched relevant databases and websites for published and unpublished trials until August 7, 2020. Two reviewers independently extracted data and assessed trial methodology. We included 33 randomized clinical trials enrolling a total of 13,312 participants. All trials were at overall high risk of bias. We identified one trial randomizing 6,425 participants to dexamethasone versus standard care. This trial showed evidence of a beneficial effect of dexamethasone on all-cause mortality (rate ratio 0.83; 95% confidence interval [CI] 0.75-0.93; p < 0.001; low certainty) and on mechanical ventilation (risk ratio [RR] 0.77; 95% CI 0.62-0.95; p = 0.021; low certainty). It was possible to perform meta-analysis of 10 comparisons. Meta-analysis showed no evidence of a difference between remdesivir versus placebo on all-cause mortality (RR 0.74; 95% CI 0.40-1.37; p = 0.34, I2 = 58%; 2 trials; very low certainty) or nonserious adverse events (RR 0.94; 95% CI 0.80-1.11; p = 0.48, I2 = 29%; 2 trials; low certainty). Meta-analysis showed evidence of a beneficial effect of remdesivir versus placebo on serious adverse events (RR 0.77; 95% CI 0.63-0.94; p = 0.009, I2 = 0%; 2 trials; very low certainty) mainly driven by respiratory failure in one trial. Meta-analyses and trial sequential analyses showed that we could exclude the possibility that hydroxychloroquine versus standard care reduced the risk of all-cause mortality (RR 1.07; 95% CI 0.97-1.19; p = 0.17; I2 = 0%; 7 trials; low certainty) and serious adverse events (RR 1.07; 95% CI 0.96-1.18; p = 0.21; I2 = 0%; 7 trials; low certainty) by 20% or more, and meta-analysis showed evidence of a harmful effect on nonserious adverse events (RR 2.40; 95% CI 2.01-2.87; p < 0.00001; I2 = 90%; 6 trials; very low certainty). Meta-analysis showed no evidence of a difference between lopinavir-ritonavir versus standard care on serious adverse events (RR 0.64; 95% CI 0.39-1.04; p = 0.07, I2 = 0%; 2 trials; very low certainty) or nonserious adverse events (RR 1.14; 95% CI 0.85-1.53; p = 0.38, I2 = 75%; 2 trials; very low certainty). Meta-analysis showed no evidence of a difference between convalescent plasma versus standard care on all-cause mortality (RR 0.60; 95% CI 0.33-1.10; p = 0.10, I2 = 0%; 2 trials; very low certainty). Five single trials showed statistically significant results but were underpowered to confirm or reject realistic intervention effects. None of the remaining trials showed evidence of a difference on our predefined outcomes. Because of the lack of relevant data, it was not possible to perform other meta-analyses, network meta-analysis, or individual patient data meta-analyses. The main limitation of this living review is the paucity of data currently available. Furthermore, the included trials were all at risks of systematic errors and random errors. CONCLUSIONS Our results show that dexamethasone and remdesivir might be beneficial for COVID-19 patients, but the certainty of the evidence was low to very low, so more trials are needed. We can exclude the possibility of hydroxychloroquine versus standard care reducing the risk of death and serious adverse events by 20% or more. Otherwise, no evidence-based treatment for COVID-19 currently exists. This review will continuously inform best practice in treatment and clinical research of COVID-19.
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Affiliation(s)
- Sophie Juul
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil Eik Nielsen
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Internal Medicine–Cardiology Section, Holbæk Hospital, Holbæk, Denmark
| | - Joshua Feinberg
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Faiza Siddiqui
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Caroline Kamp Jørgensen
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emily Barot
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niklas Nielsen
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Lund, Sweden
| | - Peter Bentzer
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Lund, Sweden
| | - Areti Angeliki Veroniki
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fanlong Bu
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Sarah Klingenberg
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit–Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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6
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Ma JH, Sun XY, Guo TJ, Barot E, Wang DF, Yan LL, Ni DW, Huang NH, Xie Q, Zeng J, Ou-Yang L, Liu YQ, Lu QB. Association on DISC1 SNPs with schizophrenia risk: A meta-analysis. Psychiatry Res 2018; 270:306-309. [PMID: 30286368 DOI: 10.1016/j.psychres.2018.09.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/17/2018] [Accepted: 09/22/2018] [Indexed: 01/09/2023]
Abstract
Schizophrenia is a major psychiatric disorder with complex genetic, environmental, and psychological etiologies. Although DISC1 gene has been shown as a risk factor for schizophrenia in some reports, there is a lack of a consensus. We therefore performed separate meta-analyses aiming to assess the associations between DISC1 SNPs and schizophrenia risk. We found that SNP rs821597 is significantly associated with schizophrenia risk in terms of both allelic and genotypic distribution, while SNP rs821616 is associated with schizophrenia in terms of genotypic distribution, especially in cases above 40 years old.
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Affiliation(s)
- Jia-Hui Ma
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
| | - Xiao-Yu Sun
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
| | - Tong-Jun Guo
- Graduate School of Peking Union Medical College, Beijing 100730, China.
| | - Emily Barot
- Bioinformatics Center, University of Copenhagen, Copenhagen 2200, Denmark.
| | | | - Lai-Lai Yan
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
| | - Da-Wei Ni
- Central Hospital of Fengxian, Shanghai 201499, China
| | - Ning-Hua Huang
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
| | - Qing Xie
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
| | - Jing Zeng
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
| | - Li Ou-Yang
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
| | - Ya-Qiong Liu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, No. 38 Xue-Yuan Road, Haidian District, Beijing 100191, PR China.
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